Question 1

Physicians have the right to establish their fees at a level that they believe fairly reflects the costs of providing a service.

Accepted Answer

A) True 
 B)False

Question 2

The section of the EOB that summarizes the total deductions, charges NOT covered by the plan, and the amount the patient may owe the provider is the:

Accepted Answer

A)  service information. 
B)  coverage determination. 
C)  benefit payment information. 
D)  summary information. 
A)  service information. 
B)  coverage determination. 
C)  benefit payment information. 
D)  summary information.

Question 3

If a claim is denied due to lack of medical necessity, the provider must refund any payment made by the carrier and can bill the patient for the balance.

Accepted Answer

A) True 
 B)False

Question 4

The Medicare conversion factor to be used for physician payments as of January 1, 2015, is $35.8043.

Accepted Answer

A) True 
 B)False

Question 5

The cost of malpractice insurance is highest for physicians in which of the following specialties?

Accepted Answer

A)  Obstetrics and gynecology 
B)  Cardiology 
C)  Dermatology 
D)  Neurosurgery 
A)  Obstetrics and gynecology 
B)  Cardiology 
C)  Dermatology 
D)  Neurosurgery

Question 6

A provider is paid a per-member-per-month (PMPM) fee for each enrolled member in a health plan that uses the ________ method of reimbursement.

Accepted Answer

The answer of A provider is paid a per-member-per-month (PMPM)...

Question 7

Match the following

-Unit of measurement assigned to a service based on the skill and time required to perform it

Accepted Answer

A)  deductible 
B)  electronic remittance advice (ER
A)  
C)  conversion factor 
D)  coinsurance 
E)  relative value unit
F) reason code
G) adjudication
H) copayment
I) withhold
J) allowed charge 
A)  deductible 
B)  electronic remittance advice (ER
A)  
C)  conversion factor 
D)  coinsurance 
E)  relative value unit
F) reason code
G) adjudication
H) copayment
I) withhold
J) allowed charge

Question 8

The Medicare RBRVS system first implemented in 1992 is the:

Accepted Answer

A)  relative basis for resource-valued services. 
B)  relative-based resource value scale. 
C)  resource-based relative value scale. 
D)  resource-based relative value services. 
A)  relative basis for resource-valued services. 
B)  relative-based resource value scale. 
C)  resource-based relative value scale. 
D)  resource-based relative value services.

Question 9

When third-party payers determine reimbursement, they consider UCR, which means :

Accepted Answer

A)  usual, customary, and reasonable charges. 
B)  usual and common rates. 
C)  uniform, customary reimbursement. 
D)  usual and customary resources. 
A)  usual, customary, and reasonable charges. 
B)  usual and common rates. 
C)  uniform, customary reimbursement. 
D)  usual and customary resources.

Question 10

An explanation of benefits (EOB) is notification the provider sends to the patient detailing what the insurance carrier has paid.

Accepted Answer

A) True 
 B)False

Question 11

The Medicare Fee Schedule (MFS) is based on the provider's charge-based fee schedule.

Accepted Answer

A) True 
 B)False

Question 12

The nationally uniform relative values are adjusted by:

Accepted Answer

A)  physician training and specialty. 
B)  geographic practice cost differences. 
C)  liability insurance cost differences. 
D)  the number of employees of the practice. 
A)  physician training and specialty. 
B)  geographic practice cost differences. 
C)  liability insurance cost differences. 
D)  the number of employees of the practice.

Question 13

Where can a medical office specialist find the annually established Medicare conversion factor (MCF)?

Accepted Answer

The updated MCF is p

Question 14

The Medicare Shared Savings Program is the most well-known and standardized example of value-based reimbursement.

Accepted Answer

A) True 
 B)False

Question 15

What information is found on the explanation of benefits (EOB)?

Accepted Answer

The EOB states the status of the claim,

Question 16

A provider who is able to balance-bill a patient for the amount over the carrier's allowed charge is a(n):

Accepted Answer

A)  contracted provider. 
B)  independent provider. 
C)  nonparticipating provider. 
D)  participating provider. 
A)  contracted provider. 
B)  independent provider. 
C)  nonparticipating provider. 
D)  participating provider.

Question 17

The amount of covered expenses that a policyholder must pay before insurance benefits begin is the ________.

Accepted Answer

The answer of The amount of covered expenses that a...

Question 18

Resource-based fee structures consider all of the following factors EXCEPT the:

Accepted Answer

A)  provider's location. 
B)  work involved. 
C)  overhead (expense) involved. 
D)  malpractice risk. 
A)  provider's location. 
B)  work involved. 
C)  overhead (expense) involved. 
D)  malpractice risk.

Question 19

The first step that the medical office specialist is responsible for before submitting a medical claim is:

Accepted Answer

A)  verifying patient insurance benefits. 
B)  obtaining correct and complete patient information. 
C)  entering patient information data into the computer. 
D)  posting charges and diagnoses. 
A)  verifying patient insurance benefits. 
B)  obtaining correct and complete patient information. 
C)  entering patient information data into the computer. 
D)  posting charges and diagnoses.

Physicians have the right to establish their fees at a level that they believe fairly reflects the costs of providing a service.

The section of the EOB that summarizes the total deductions, charges NOT covered by the plan, and the amount the patient may owe the provider is the:

If a claim is denied due to lack of medical necessity, the provider must refund any payment made by the carrier and can bill the patient for the balance.

The Medicare conversion factor to be used for physician payments as of January 1, 2015, is $35.8043.

The cost of malpractice insurance is highest for physicians in which of the following specialties?

A provider is paid a per-member-per-month (PMPM) fee for each enrolled member in a health plan that uses the ________ method of reimbursement.

Match the following -Unit of measurement assigned to a service based on the skill and time required to perform it

The Medicare RBRVS system first implemented in 1992 is the:

When third-party payers determine reimbursement, they consider UCR, which means :

An explanation of benefits (EOB) is notification the provider sends to the patient detailing what the insurance carrier has paid.

The Medicare Fee Schedule (MFS) is based on the provider's charge-based fee schedule.

The nationally uniform relative values are adjusted by:

Where can a medical office specialist find the annually established Medicare conversion factor (MCF)?

The Medicare Shared Savings Program is the most well-known and standardized example of value-based reimbursement.

What information is found on the explanation of benefits (EOB)?

A provider who is able to balance-bill a patient for the amount over the carrier's allowed charge is a(n):

The amount of covered expenses that a policyholder must pay before insurance benefits begin is the ________.

Resource-based fee structures consider all of the following factors EXCEPT the:

The first step that the medical office specialist is responsible for before submitting a medical claim is:

Introduction to Professional Billing and Coding Careers

Understanding Managed Care: Insurance Plans

Understanding Managed Care: Medical Contracts and Ethics

Introduction to the Health Insurance Portability and Accountability Act Hipaa

ICD-10 Cm Medical Coding

Introduction to CPT and Place of Coding Services

Coding Procedures and Services

Hcpcs Coding and Compliance

Auditing

Physician Medical Billing

Hospital Medical Billing

Medicare Medical Billing

Medicaid Medical Billing

Tricare Medical Billing

Refunds and Appeals

Workers Compensation

Filters

Exam 15: Explanation of Benefits and Payment Adjudication

Physicians have the right to establish their fees at a level that they believe fairly reflects the costs of providing a service.

The section of the EOB that summarizes the total deductions, charges NOT covered by the plan, and the amount the patient may owe the provider is the:

If a claim is denied due to lack of medical necessity, the provider must refund any payment made by the carrier and can bill the patient for the balance.

The Medicare conversion factor to be used for physician payments as of January 1, 2015, is $35.8043.

The cost of malpractice insurance is highest for physicians in which of the following specialties?

A provider is paid a per-member-per-month (PMPM) fee for each enrolled member in a health plan that uses the ________ method of reimbursement.

Match the following -Unit of measurement assigned to a service based on the skill and time required to perform it

The Medicare RBRVS system first implemented in 1992 is the:

When third-party payers determine reimbursement, they consider UCR, which means :

An explanation of benefits (EOB) is notification the provider sends to the patient detailing what the insurance carrier has paid.

The Medicare Fee Schedule (MFS) is based on the provider's charge-based fee schedule.

The nationally uniform relative values are adjusted by:

Where can a medical office specialist find the annually established Medicare conversion factor (MCF)?

The Medicare Shared Savings Program is the most well-known and standardized example of value-based reimbursement.

What information is found on the explanation of benefits (EOB)?

A provider who is able to balance-bill a patient for the amount over the carrier's allowed charge is a(n):

The amount of covered expenses that a policyholder must pay before insurance benefits begin is the ________.

Resource-based fee structures consider all of the following factors EXCEPT the:

The first step that the medical office specialist is responsible for before submitting a medical claim is:

Introduction to Professional Billing and Coding Careers

Understanding Managed Care: Insurance Plans

Understanding Managed Care: Medical Contracts and Ethics

Introduction to the Health Insurance Portability and Accountability Act Hipaa

ICD-10 Cm Medical Coding

Introduction to CPT and Place of Coding Services

Coding Procedures and Services

Hcpcs Coding and Compliance

Auditing

Physician Medical Billing

Hospital Medical Billing

Medicare Medical Billing

Medicaid Medical Billing

Tricare Medical Billing

Refunds and Appeals

Workers Compensation

Filters